Publications by authors named "Kirstin W Scott"

18 Publications

  • Page 1 of 1

Differences Between Emergency Department and Urgent Care Users for Low-acuity Health Needs: A Public Opinion Analysis.

Acad Emerg Med 2021 02 24;28(2):240-243. Epub 2020 Jul 24.

the, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/acem.14047DOI Listing
February 2021

COVID-19 preparedness in Malawi: a national facility-based critical care assessment.

Lancet Glob Health 2020 07 25;8(7):e890-e892. Epub 2020 May 25.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2214-109X(20)30250-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247792PMC
July 2020

Fostering Student-Faculty Partnerships for Continuous Curricular Improvement in Undergraduate Medical Education.

Acad Med 2019 07;94(7):996-1001

K.W. Scott is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5415-6479. D.G. Callahan is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-1413-5331. J.J. Chen is a third-year medical student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5380-4825. M.H. Lynn is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. D.J. Cote is a fourth-year medical student and PhD student, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts. A. Morenz is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. J. Fisher is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. V.L. Antoine is a second-year medical student, Harvard Medical School, Boston, Massachusetts. E.R. Lemoine is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. S.K. Bakshi is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. J. Stuart is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. E.M. Hundert is dean for medical education and Daniel D. Federman, M.D. Professor in Residence of Global Health and Social Medicine and Medical Education, Harvard Medical School, Boston, Massachusetts. B.S. Chang is advisory dean and director, Francis Weld Peabody Society, and course director, Mind, Brain and Behavior, Harvard Medical School, Boston, Massachusetts. H. Gooding is faculty mentor, Education Representatives Program, Harvard Medical School, and adolescent medicine specialist, Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.

Problem: A number of medical schools have used curricular reform as an opportunity to formalize student involvement in medical education, but there are few published assessments of these programs. Formal evaluation of a program's acceptability and use is essential for determining its potential for sustainability and generalizability.

Approach: Harvard Medical School's Education Representatives (Ed Reps) program was created in 2015 to launch alongside a new curriculum. The program aimed to foster partnerships between faculty and students for continuous and real-time curricular improvement. Ed Reps, course directors, and core faculty met regularly to convey bidirectional feedback to optimize the learning environment in real time.

Outcomes: A survey to assess the program's impact was sent to students and faculty. The majority of students (202/222; 91.0%) reported Ed Reps had a positive impact on the curriculum. Among faculty, 35/37 (94.6%) reported making changes to their courses as a result of Ed Reps feedback, and 34/37 (91.9%) agreed the program had a positive impact on the learning environment. Qualitative feedback from students and faculty demonstrated a change in school culture, reflecting the primary goals of partnership and continuous quality improvement (CQI).

Next Steps: This student-faculty partnership demonstrated high rates of awareness, use, and satisfaction among faculty and students, suggesting its potential for local sustainability and implementation at other schools seeking to formalize student engagement in CQI. Next steps include ensuring the feedback provided is representative of the student body and identifying new areas for student CQI input as the curriculum becomes more established.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000002726DOI Listing
July 2019

Impact of Affordable Care Act-related insurance expansion policies on mortality and access to post-discharge care for trauma patients: an analysis of the National Trauma Data Bank.

J Trauma Acute Care Surg 2019 02;86(2):196-205

From the Department of Surgery (J.W.S.), Harborview Medical Center, University of Washington, Seattle, WA; Department of Surgery (P.U.N., A.S., A.H.H), Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Department of Surgery (T.U.-L., A.S., A.H.H.), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (K.W.S.), Boston, MA; Yale School of Medicine (C.K.Z.), New Haven, CT; and Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery (A.S., A.H.H.), Brigham and Women's Hospital, Boston, MA.

Background: Uninsured trauma patients have worse outcomes and worse access to post-discharge care that is critically important for recovery after injury. Little is known regarding the impact of the insurance coverage expansion policies of the Affordable Care Act (ACA), most notably state-level Medicaid expansion, on trauma patients. In this study, we examine the national impact of these policies on payer mix, inpatient mortality, and access to post-acute care for trauma patients.

Methods: We used the 2011-2016 National Trauma Data Bank to evaluate for changes in insurance coverage among trauma patients 18-64 years old. Our pre-/post-expansion models defined 2011-2013 as the pre-policy period, 2015-2016 as the post-policy period, and 2014 as a washout year. To evaluate for policy-associated changes in inpatient mortality and discharge disposition among the policy-eligible sample, we leveraged multivariable linear regression techniques to adjust for year-to-year variation in patient demographics, injury characteristics, and facility traits. We then examined the relationship between the magnitude of facility-level reductions in uninsured patients and access to post-acute care after policy implementation.

Results: We identified 1,656,469 patients meeting inclusion criteria between 2011 and 2016. The pre-policy uninsured rate of 23.4% fell by 5.9 percentage-points after coverage expansion (p < 0.001), with a corresponding 7.5 percentage-point increase in Medicaid coverage (p < 0.001). After policy implementation, there were no significant changes in inpatient mortality. However, there was a >30% relative increase in discharge to a post-acute care facility and a similar increase in discharge with home health services (p < 0.001 for both). The greatest gains in access to post-acute services were seen among facilities with the greatest reductions in their uninsured rate (p = 0.003).

Conclusion: ACA-related coverage expansion policies, most notably Medicaid expansion, were associated with a >25% reduction in the uninsured rate among non-elderly adult trauma patients. Although no immediate impact on inpatient mortality was seen, insurance coverage expansion was associated with a higher proportion of patients receiving critically important post-discharge care.

Level Of Evidence: Epidemiological, level III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000002117DOI Listing
February 2019

Changes in Hospital-Physician Affiliations in U.S. Hospitals.

Ann Intern Med 2018 01;168(2):156-157

From Harvard Medical School, Boston; Brigham and Women's Hospital, Boston; Harvard University, Cambridge; and Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/L17-0686DOI Listing
January 2018

Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.

J Trauma Acute Care Surg 2017 05;82(5):887-895

From the Department of Surgery, Center for Surgery and Public Health (J.W.S., P.N., T.C.T., A.S., A.H.H.), Brigham & Women's Hospital; Program in Global Surgery and Social Change (J.W.S., M.G.S.), Harvard Medical School, Boston; John F. Kennedy School of Government (P.U.), Harvard University, Cambridge, Massachusetts; David Geffen School of Medicine at the University of California (P.U.), Los Angeles, Los Angeles, California; Harvard Business School (P.N.); Department of Health Policy and Management (T.C.T.), Harvard T.H. Chan School of Public Health; Harvard Medical School (K.W.S.); Department Of Otolaryngology & Office of Global Surgery (M.G.S.), Massachusetts Eye & Ear Infirmary, Boston; Department of Economics (D.M.C.), Harvard University; National Bureau of Economics Research (D.M.C.); and Division of Trauma, Department of Surgery (A.S., A.H.H.), Brigham & Women's Hospital, Boston, Massachusetts.

Background: Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect.

Methods: We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population.

Results: There were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95% CI, 10.8-14.7), yielding a national margin of -7.9% (95% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4% (95% CI, -0.3 to +3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains.

Conclusion: Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers' financial viability and their ability to provide care for their communities.

Level Of Evidence: Economic analysis, level II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000001400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468098PMC
May 2017

Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda.

Acad Med 2017 05;92(5):649-658

C. Cancedda is associate physician, Division of Global Health Equity, Brigham and Women's Hospital, and instructor in medicine and in global health and social medicine, Harvard Medical School, Boston, Massachusetts. R. Riviello is director of global surgery programs, Center for Surgery and Public Health, associate surgeon, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, and assistant professor of surgery and of global health and social medicine, Harvard Medical School, Boston, Massachusetts. K. Wilson is associate director, Global Pediatrics Program, and codirector, Global Pediatric Fellowship, Boston Children's Hospital, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts. K.W. Scott is a medical student, Harvard Medical School, and research assistant, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. M. Tuteja is director for global health and research programs, Brigham and Women's Hospital, Boston, Massachusetts. J.R. Barrow is assistant dean of global and community health, executive director of the initiative to integrate oral health and medicine, and lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts. B. Hedt-Gauthier is assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is director of the program in global noncommunicable diseases (NCDs) and social change, Harvard Medical School, cardiologist, Cardiovascular Division and the Division of Global Health Equity, Brigham and Women's Hospital, senior health and policy advisor on NCDs, Partners In Health, and assistant professor of medicine and assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is also co-chair, Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion. J. Scott is faculty, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, associate scientist, Division of Women's Health, Brigham and Women's Hospital, and instructor, Harvard Medical School, Boston, Massachusetts. D. Milner is associate medical director of microbiology, Brigham and Women's Hospital, and associate professor, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. G. Raviola is assistant professor of psychiatry and assistant professor of global health and social medicine, Harvard Medical School, and director of the psychiatry quality programs, Boston Children's Hospital, Boston, Massachusetts. B. Weissman is vice chair emeritus of radiology, Brigham and Women's Hospital, and professor in radiology, Harvard Medical School, Boston, Massachusetts. S. Smith is chief and Distinguished Barbara N. Weissman Chair, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, radiology lead, Rwanda Human Resources for Health Program, associate residency training director, Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, co-medical director, Orthopaedic and Arthritis Center, Brigham and Women's Hospital, assistant director, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, and associate professor, Harvard Medical School, Boston, Massachusetts. T. Nuthulaganti is director, Health Workforce, Clinton Health Access Initiative, Boston, Massachusetts. C.D. McClain is senior associate in perioperative anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, and assistant professor of anesthesia, Harvard Medical School, Boston, Massachusetts. B.E. Bierer is senior physician, Brigham and Women's Hospital, professor of medicine (pediatrics), Harvard Medical School, and faculty director, Multi-Regional Clinical Trials Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. P.E. Farmer is Kolokotrones University Professor of Global Health and Social Medicine, Harvard University, chair, Department of Global Health and Social Medicine, Harvard Medical School, and chief, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. A.E. Becker is Maude and Lillian Presley Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. A. Binagwaho is former Minister of Health of Rwanda, Kigali, Rwanda, and is currently senior lecturer, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, professor of pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and professor of the practice of global health delivery, University of Global Health Equity, Kigali, Rwanda. J. Rhatigan is associate professor of medicine and associate professor of global health and social medicine, Harvard Medical School, associate chief, Division of Global Health Equity, and director, Hiatt Global Health Equity Residency Program, Brigham and Women's Hospital, Boston, Massachusetts. D.E. Golan is dean for basic science and graduate education, special advisor for global programs, George R. Minot Professor of Medicine, and professor of biological chemistry and molecular pharmacology, Harvard Medical School, and senior physician, Brigham and Women's Hospital, Boston, Massachusetts.

A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000001638DOI Listing
May 2017

Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone.

J Infect Dis 2016 10 28;214(suppl 3):S153-S163. Epub 2016 Sep 28.

Partners In Health.

An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050485PMC
http://dx.doi.org/10.1093/infdis/jiw345DOI Listing
October 2016

Changes in Hospital-Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care.

Ann Intern Med 2017 Jan 20;166(1):1-8. Epub 2016 Sep 20.

From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.

Background: Growing evidence shows that hospitals are increasingly employing physicians.

Objective: To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model.

Design: Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012.

Setting: U.S. nonfederal acute care hospitals.

Participants: 803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region.

Intervention: Hospitals' conversion to an employment relationship with any of their privileged physicians.

Measurements: Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.

Results: In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.

Limitations: The measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear.

Conclusion: During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.

Primary Funding Source: Agency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M16-0125DOI Listing
January 2017

Sick of Health Care Politics? Comparing Views of Quality of Care Between Democrats and Republicans.

J Healthc Qual 2016 Nov/Dec;38(6):e39-e51

Objective: Improving the quality of care delivered by the U.S. health care system is a topic of important policy and political debate. Although public opinion surveys have shown concerns regarding the state of quality of care nationally, the majority of Americans are satisfied with the quality of care they personally receive. Studies have shown that Republicans and Democrats may differ in these views.

Methods: We used a 2012 national survey of 1,508 American adults that captured perceptions of quality, political party, medical experiences, and self-reported interactions with the health care system due to an illness to examine these differences.

Results: Regardless of having a recent illness or hospitalization, Democrats generally expressed greater concerns about the country's state of health care quality relative to Republicans. Partisan differences also emerged when identifying the most important problems contributing to quality-of-care deficiencies in the nation. However, partisan differences were nonexistent on measures related to self-reported experiences with quality of care.

Conclusion: Although their individual experiences with quality of care do not differ, Republicans and Democrats differ in their views on national quality-of-care issues. This may have implications for efforts to improve quality of care in the current polarized healthcare environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000060DOI Listing
April 2018

Early childhood development in Rwanda: a policy analysis of the human rights legal framework.

BMC Int Health Hum Rights 2016 Jan 12;16. Epub 2016 Jan 12.

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.

Background: Early childhood development (ECD) is a critical period that continues to impact human health and productivity throughout the lifetime. Failing to provide policies and programs that support optimal developmental attainment when such services are financially and logistically feasible can result in negative population health, education and economic consequences that might otherwise be avoided. Rwanda, with its commitment to rights-based policy and program planning, serves as a case study for examination of the national, regional, and global human rights legal frameworks that inform ECD service delivery.

Discussion: In this essay, we summarize key causes and consequences of the loss of early developmental potential and how this relates to the human rights legal framework in Rwanda. We contend that sub-optimal early developmental attainment constitutes a violation of individuals' rights to health, education, and economic prosperity. These rights are widely recognized in global, regional and national human rights instruments, and are guaranteed by Rwanda's constitution. Recent policy implementation by several Rwandan ministries has increased access to health and social services that promote achievement of full developmental potential. These ECD-centric activities are characterized by an integrated approach to strengthening the services provided by several public sectors. Combining population level activities with those at the local level, led by local community health workers and women's councils, can bolster community education and ensure uptake of ECD services.

Conclusions: Realization of the human rights to health, education, and economic prosperity requires and benefits from attention to the period of ECD, as early childhood has the potential to be an opportunity for expedient intervention or the first case of human rights neglect in a lifetime of rights violations. Efforts to improve ECD services and outcomes at the population level require multisector collaboration at the highest echelons of government, as well as local education and participation at the community level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12914-016-0076-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709993PMC
January 2016

Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients.

J Am Coll Surg 2015 Aug 9;221(2):495-501.e1. Epub 2015 Apr 9.

Department of Medicine, Massachusetts General Hospital, Boston, MA.

Background: Disparities in trauma outcomes based on insurance and race are especially pronounced among young adults who have relatively high uninsured rates and incur a disproportionate share of trauma in the population. The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parent's health insurance plans until age 26 years, leading to >3 million young adults gaining insurance. We investigated the impact of the DCP on racial disparities in coverage expansion among trauma patients.

Study Design: Using the 2007-2012 National Trauma Data Bank, we compared changes in coverage among 529,844 19- to 25-year-olds with 484,974 controls aged 27 to 34 years not affected by the DCP. Subgroup analyses were conducted by race and ethnicity and by census region.

Results: The pre-DCP uninsured rates among young adults were highest among black patients (48.1%) and Hispanic patients (44.3%), and significantly lower among non-Hispanic white patients (28.9%). However, non-Hispanic white young adults experienced a significantly greater absolute reduction in the uninsured rate (-4.9 percentage points) than black (-2.9; p = 0.01) and Hispanic (-1.7; p < 0.001) young adults. These absolute reductions correspond to a 17.0% relative reduction in the uninsured rate for white patients, 6.1% for black patients, and 3.7% for Hispanic patients. Racial disparities in the provision's impact on coverage among trauma patients were largest in the South and West census regions (p < 0.01).

Conclusions: Although the DCP increased insurance coverage for young adult trauma patients of all races, both absolute and relative racial disparities in insurance coverage widened. The extent of these racial disparities also differed by geographic region. Although this policy produced overall progress toward greater coverage among young adults, its heterogeneous impact by race has important implications for future disparities research in trauma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamcollsurg.2015.03.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676942PMC
August 2015

Maximizing the Impact of Training Initiatives for Health Professionals in Low-Income Countries: Frameworks, Challenges, and Best Practices.

PLoS Med 2015 Jun 16;12(6):e1001840. Epub 2015 Jun 16.

Harvard Medical School, Boston, Massachusetts, United States of America; Ministry of Health of Rwanda, Kigali, Rwanda; Geisel School of Medicine-Dartmouth, Hanover, New Hampshire, United States of America.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pmed.1001840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469419PMC
June 2015

The 2014 governors' races and health care: a campaign web site analysis.

Inquiry 2015 5;52. Epub 2015 May 5.

Harvard T.H. Chan School of Public Health, Boston, MA, USA.

The November 2014 midterm election was the first election since key coverage provisions of the Affordable Care Act (ACA) were implemented, including the Medicaid expansion and creation of the health insurance exchanges. The pre-election variability in the states' implementation of these provisions coupled with the large number of states selecting their next governor made the election important at the state level. To better understand the role of health care in the recent gubernatorial elections, we analyzed health policy content presented by 71 candidates for governor on their campaign Web sites. Nearly 80% of all candidates discussed health policy on their Web site, including the subset of the 36 winning governors. The predominant focus of health policy content was on the ACA as a whole or its provisions. Medicaid was discussed more often by candidates in non-expansion states than those from expansion states. Based on the statements of winning governors, we expect serious consideration of the Medicaid expansion to occur in at least 4 states, whereas 2 states may make efforts to reverse course. Relatively few winning governors (33%) mentioned the exchanges. Only 1 expressed interest in switching from the federal exchange to a state exchange, which has particular relevance given the Supreme Court's pending decision on King v. Burwell that could invalidate tax credits on the federal exchange. The prominence of health care in the gubernatorial campaigns strengthens the likelihood that governors will play an influential role in the health system's future, especially as the ACA undergoes further federal debate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0046958015584798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813621PMC
June 2015

Improving the world's health through the post-2015 development agenda: perspectives from Rwanda.

Int J Health Policy Manag 2015 Apr 1;4(4):203-5. Epub 2015 Mar 1.

Harvard University, Cambridge, MA, USA.

The world has made a great deal of progress through the Millennium Development Goals (MDGs) to improve the health and well-being of people around the globe, but there remains a long way to go. Here we provide reflections on Rwanda's experience in working to meet the health-related targets of the MDGs. This experience has informed our proposal of five guiding principles that may be useful for countries to consider as the world sets and moves forward with the post-2015 development agenda. These include: 1) advancing concrete and meaningful equity agendas that drive the post-2015 goals; 2) ensuring that goals to meet Universal Health Coverage (UHC) incorporate real efforts to focus on improving quality and not only quantity of care; 3) bolstering education and the internal research capacity within countries so that they can improve local evidence-based policy-making; 4) promoting intersectoral collaboration to achieve goals, and 5) improving collaborations between multilateral agencies - that are helping to monitor and evaluate progress towards the goals that are set - and the countries that are working to achieve improvements in health within their nation and across the world.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/ijhpm.2015.46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380561PMC
April 2015

Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.

Health Aff (Millwood) 2015 Jan;34(1):125-33

Zirui Song is a resident in internal medicine at the Massachusetts General Hospital and a clinical fellow at Harvard Medical School, both in Boston.

Insurance coverage has increased among young adults as a result of the Affordable Care Act (ACA) provision that allows young adults to remain covered under their parents' plans until age twenty-six. However, little is known about the provision's effects on the clinical outcomes and insurance coverage of patients with trauma--the most frequent cause of death and physical disability among young adults. Using 2007-12 data from the National Trauma Data Bank, we conducted a difference-in-differences analysis of coverage rates among trauma patients ages 19-25 (compared to patients ages 26-34, who served as the control group), and we examined trauma-relevant outcomes by patient, injury, and hospital characteristics. We found a 3.4-percentage-point decrease in uninsurance status among younger trauma patients following the policy change. The decrease was concentrated among men, non-Hispanic whites, those with relatively less severe injuries, and those who presented to nonteaching hospitals. We did not detect significant changes in the use of intensive care or in overall mortality. The heterogeneous coverage impact of the ACA dependent coverage provision on high- versus low-risk trauma patients has implications for future efforts to expand coverage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1377/hlthaff.2014.0880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692158PMC
January 2015

Putting quality on the global health agenda.

N Engl J Med 2014 Jul;371(1):3-5

From the Initiative on Global Health Quality, Department of Health Policy and Management, Harvard School of Public Health (K.W.S., A.K.J.), and the Division of General Medicine, Brigham and Women's Hospital (A.K.J.) - both in Boston; and the Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA (K.W.S.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMp1402157DOI Listing
July 2014

ResearchMatch: a national registry to recruit volunteers for clinical research.

Acad Med 2012 Jan;87(1):66-73

Office of Research Informatics, Vanderbilt University, Nashville, Tennessee 37203, USA.

The authors designed ResearchMatch, a disease-neutral, Web-based recruitment registry to help match individuals who wish to participate in clinical research studies with researchers actively searching for volunteers throughout the United States. In this article, they describe ResearchMatch's stakeholders, workflow model, technical infrastructure, and, for the registry's first 19 months of operation, utilization metrics. Having launched volunteer registration tools in November 2009 and researcher registration tools in March 2010, ResearchMatch had, as of June 2011, registered 15,871 volunteer participants from all 50 states. The registry was created as a collaborative project for institutions in the Clinical and Translational Science Awards (CTSA) consortium. Also as of June 2011, a total of 751 researchers from 61 participating CTSA institutions had registered to use the tool to recruit participants into 540 active studies and trials. ResearchMatch has proven successful in connecting volunteers with researchers, and the authors are currently evaluating regulatory and workflow options to open access to researchers at non-CTSA institutions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0b013e31823ab7d2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688834PMC
January 2012